Press Release

Highmark makes change to hospital pay-for-performance program to place more emphasis on decreasing preventable readmissions

July 11, 2012

PITTSBURGH – To help improve member care, Highmark’s Quality Blue pay-for-performance hospital program now requires all participating hospitals to measure and reduce the number of hospital readmissions. Beginning this month, the program, which had previously allowed hospitals to choose any of the program indicators, will now require all participating hospitals to measure this important indicator in addition to their regular selections.

“Each year, preventable hospital readmissions cost the U.S. health care system an estimated $25 billion,” said Linda Weiland, vice president of provider network innovations and partnerships at Highmark. “Having increased attention on the preventable root causes of readmissions should help to improve the quality of care provided to our members and reduce health care costs.” A “readmission” is defined as any new admission to the hospital which follows within 30 days of discharge from the hospital.

According to a recent Pennsylvania Health Care Cost Containment Council (PHC4) report, 185,190 of the approximately 1.5 million inpatient stays in 2010, or about 12.4 percent, fell into the potentially preventable classification.

Highmark’s Quality Blue program will require hospitals to focus on 30 day readmissions, identifying admissions within 30 days of a previous hospital stay providing an important overall measure of hospital quality. Readmissions can be caused by a number factors such as: poor discharge procedures, inadequate follow up care and medication related issues. Conditions that cause the most readmissions include heath failure and Chronic Obstructive Pulmonary Disease (COPD).

Highmark’s Quality Blue hospital program began in 2001. Today, the program includes 90 hospitals in Pennsylvania and West Virginia. The goals of the program include providing consumers information about hospital quality and safety and aligning provider reimbursement and performance. Over the past decade, the program has been recognized nationally for its efforts to save lives and millions of health care dollars.

“Patient safety is a top priority at our hospital and it just makes sense for the hospital staff to improve our efforts on this important quality measure,” said Paul Bacharach, president and CEO of Uniontown Hospital. “We will continue to focus improving our transitions of patients from an inpatient hospital stay to home or another facility. Patients need clear discharge instructions and that includes medication instructions and information on follow-up care. They need to clearly understand their medical condition so they and their family can be involved.”

While this requirement is new for participating hospitals, the voluntary option to measure readmissions has been part of Quality Blue for a number of years. In fiscal year 2011, 31 Quality Blue hospitals measured and worked to reduce their readmission rates.

“Readmissions is also focused on nationally because it is so crucial. By reducing readmissions, we can reduce overall health care spending,” said Weiland.

Hospitals that participate in the Quality Blue program typically outperform other hospitals in numerous quality areas that are tracked. To see a list of participating hospitals and learn more about the entire program visit the Highmark newsroom.

About Highmark Inc.Highmark Inc., based in Pittsburgh, is an independent licensee of the Blue Cross and Blue Shield Association, an association of independent Blue Cross and Blue Shield plans. Highmark serves 4.9 million members in Pennsylvania and West Virginia through the company's health care benefits business and is one of the largest Blue plans in the nation. Highmark has 20,000 employees across the country. For more than 70 years, Highmark's commitment to the community has consistently been among the company’s highest priorities as it strives to positively impact the communities where we do business. For more information, visit www.highmark.com.

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